Effectiveness of inactivated influenza vaccine in children during the 2023/24 season: The first season after relaxation of intensive COVID-19 measures.

BACKGROUND: The annual administration of the influenza vaccine is the most effective method for preventing influenza. We have evaluated the effectiveness of the inactivated influenza vaccine in children aged 6 months to 15 years across the seasons from 2013/2014 to 2022/2023. This study aims to investigate the effectiveness of the inactivated influenza vaccine in the 2023/2024 season, the first year following the easing of strict COVID-19 measures, and possibly the last season when only the inactivated vaccine is available on the market. METHODS: Adjusted vaccine effectiveness for the 2023/2024 season was assessed using a test-negative case-control design, with results based on polymerase chain reaction and rapid influenza diagnostic tests. Vaccine effectiveness was calculated by influenza type and patient hospitalization/outpatient status. RESULTS: A total of 1832 children were recruited. The inactivated influenza vaccine was effective in preventing both symptomatic influenza A and B in both inpatient and outpatient settings. Overall vaccine effectiveness for influenza A was 51% (95% confidence interval [CI], 23%-69%, n = 930) in inpatient settings and 54% (95%CI, 27%-71%, n = 559) in outpatient settings. For influenza B, effectiveness was 60% (95%CI, 22%-79%, n = 859) in inpatient settings and 56% (95%CI, 26%-74%, n = 558) in outpatient settings. Analysis suggested that administering two doses enhanced effectiveness specifically against influenza B. CONCLUSIONS: This is the first study to demonstrate influenza vaccine effectiveness in children after the relaxation of strict COVID-19 measures in Japan (2023/2024). We recommend the current inactivated vaccine for preventing both influenza A and B in children, with consideration for the potential use of two doses to enhance effectiveness against influenza B.

[DEVELOPMENT OF MEDICAL EDUCATIONAL PROGRAM FOR PEDIATRICIANS TO IMPROVE THEIR BEHAVIOR IN THE MANAGEMENT OF FOOD ALLERGY].

BACKGROUND: Many children are suffering from food allergy, however, not all of them are treated properly by pediatricians based on the latest practice guideline. The guideline does not recommend excessive elimination diet, but suggests initial appropriate skincare treatment before examining candidate allergens for food-allergy-patients with atopic dermatitis. We developed and evaluated a curriculum for continuing medical education for pediatrician about food allergy. METHODS: We provided a medical educational program for pediatricians at the Division of Allergy in National Center for Child Health and Development, from January 2013 to January 2014. The program was aimed to improve their behavior in the management of food allergy, if they excessively eliminated diet from the patients and did not treat atopic dermatitis appropriately. The program was constituted of SBOs and educational strategy. Participant's self evaluation of learning and that of behavior were carried out before and after the training, and their scores were analyzed for the program evaluation. RESULTS: Thirty-five participants completed the program. All the scores rating 22 items for evaluation of learning were increased. Five items out of 7 about evaluation of behavior were significantly improved. CONCLUSION: We developed a medical educational program about food allergy for pediatricians. After training based on this program, the participants' knowledge and skills were improved and their behavior was desirably modified.

Effects of tryptophan-rich breakfast and light exposure during the daytime on melatonin secretion at night.

BACKGROUND: The purpose of the present study is to investigate effects of tryptophan intake and light exposure on melatonin secretion and sleep by modifying tryptophan ingestion at breakfast and light exposure during the daytime, and measuring sleep quality (by using actigraphy and the OSA sleep inventory) and melatonin secretion at night. METHODS: Thirty three male University students (mean ± SD age: 22 ± 3.1 years) completed the experiments lasting 5 days and 4 nights. The subjects were randomly divided into four groups: Poor*Dim (n = 10), meaning a tryptophan-poor breakfast (55 mg/meal) in the morning and dim light environment (<50 lx) during the daytime; Rich*Dim (n = 7), tryptophan-rich breakfast (476 mg/meal) and dim light environment; Poor*Bright (n = 9), tryptophan-poor breakfast and bright light environment (>5,000 lx); and Rich*Bright (n = 7), tryptophan-rich breakfast and bright light. RESULTS: Saliva melatonin concentrations on the fourth day were significantly lower than on the first day in the Poor*Dim group, whereas they were higher on the fourth day in the Rich*Bright group. Creatinine-adjusted melatonin in urine showed the same direction as saliva melatonin concentrations. These results indicate that the combination of a tryptophan-rich breakfast and bright light exposure during the daytime could promote melatonin secretion at night; further, the observations that the Rich*Bright group had higher melatonin concentrations than the Rich*Dim group, despite no significant differences being observed between the Poor*Dim and Rich*Dim groups nor the Poor*Bright and Rich*Bright groups, suggest that bright light exposure in the daytime is an important contributor to raised melatonin levels in the evening. CONCLUSIONS: This study is the first to report the quantitative effects of changed tryptophan intake at breakfast combined with daytime light exposure on melatonin secretion and sleep quality. Evening saliva melatonin secretion changed significantly and indicated that a tryptophan-rich breakfast and bright light exposure during the daytime promoted melatonin secretion at this time.

Which characteristic of Natto: appearance, odor, or taste most affects preference for Natto.

BACKGROUND: In Japan, consumption of Natto, a fermented bean dish, is recommended because of its high quality protein, digestibility in the gut and its preventive effect on blood clot formation due to high vitamin K content. However, consumption of Natto in Kansai and the Chugoku area (the western part of Honshu) is less than that in the other areas of Japan probably because of a "food related cultural inhibition". In this study, we determined which characteristic of Natto (appearance, odor or taste) most affect subjects' perception of sensory attributes by observation of brain hemodynamics in relation to subjects' preference for Natto. FINDINGS: In this experiment, we defined each subject's changes in brain hemodynamics as (+) or (-) corresponding to an increase or a decrease in total hemoglobin concentration after stimuli compared to that before stimuli. As a result, there was no relation between preference for Natto and change in brain hemodynamics by the stimuli of "looking at" or "smelling", while there was a significant relationship between preference and stimulus of "ingestion"; (+) : (-) = 21:15 in the subjects of the "favorite" group and (+):(-) = 30:7 in the subjects of the "non-favorite" group (P = 0.034). CONCLUSION: This result indicated that characteristic "taste" of Natto most affects preference for Natto.

[Pompholyx-like reactions occurring early in treatment of severe atopic dermatitis in children and adolescence].

BACKGROUND: Pompholyx-like reactions may develop for aggressive atopic dermatitis treatments in the incipient phase despite of improvement of other skin symptoms. METHODS: Eighty-nine patients admitted to National Center for Child Health and Development for treatment of atopic dermatitis between April 2007 and March 2009 were recruited. RESULTS: Pompholyx-like reactions were seen in thirteen out of eighty-nine patients between 4 and 32 (mean 16.7±10.4) days following admission. The mean age of patients with these reactions was 6.2±6.1 years (range of 3 months to 23 years). At the time of admission, practical issues of scoring atopic dermatitis: the SCORAD was assessed. The values of SCORAD index with pompholyx were ranging from 16-91 (mean 50.8±17.9), and the index except under one-year old were significantly higher than unaffected patients. These patients were evaluated into their medical record, for evidence of Pompholyx-like lesions: a bilateral vesicular eruption confined to the skin of the palms, soles, or sides of the fingers. Topical corticosteroids are used to treat Pompholyx-like reactions, all them achieved remission between 4 and 50 days (mean 18.5±12.0). In general, pompholyx is more common in summer. However, it seems that there were no significant differences in the pompholyx-like reactions incidence between in summer and in winter. CONCLUSION: The factor for the occurrence of pompholyx-like lesions remains unexplained. Although the original symptoms of eczema were improved, pompholyx-like eczema breakout, therefore, patients often feel uneasy. We should be aware of this clinical condition.

Seasonal variation in amount of unabsorbed dietary carbohydrate from the intestine after breakfast in young female Thai subjects: comparison with that of Japanese subjects.

Previously, using the breath hydrogen test, we investigated seasonal variations in the amount of unabsorbed dietary carbohydrate from the intestine after breakfast in female Japanese university students and young Polish subjects. In the study we found that there were significant seasonal variations in both countries with the smallest unabsorbed dietary carbohydrate in autumn and the biggest in winter. Considering the theory of human adaptation to living environments, we suggested a hypothesis that this seasonal variation in the efficiency of carbohydrate absorption in the intestine may reflect human adaptation and/or a response to seasonal change in the living environment. In order to prove this hypothesis, we carried out the same examination in Chiang Mai, Thailand, where there is different seasonal change in the living environment from that of Japan and of Poland. In this examination, we measured the amount of unabsorbed dietary carbohydrate (UDC) from the intestine after breakfast and the oro-cecal transit time (OCTT) of the breakfast in female Thai university students using the same method and experimental protocol as previously carried out with Japanese subjects. We conducted the examination in April (the hot season), in August-September (the rainy season), and in November-December (the dry season) of 2008, at the Medical School of Chiang Mai University, Chiang Mai. The results are summarized as follows: (1) there were no significant seasonal variations in the amounts of unabsorbed dietary carbohydrate from breakfast in Thai subjects; (2) there were no significant seasonal variations in the oro-cecal transit times of breakfast or a soluble indigestible trisaccharide (lactosucrose) solution in Thai subjects; (3) there were no significant differences in the oro-cecal transit times of breakfast between the two countries in any season; (4) the UDC of Thai subjects was significantly less than that of the Japanese subjects in the three seasons. These results suggest that differences in seasonal change in a living environment have different effects on seasonal variations in the efficiency of carbohydrate absorption in the intestine after breakfast.

Seasonal variation in the amount of dietary carbohydrate not absorbed from the intestine after breakfast in elderly Japanese females.

It was previously shown that there is seasonality in the amount of dietary carbohydrate not absorbed from the intestine after breakfast, the amount of carbohydrate in winter being significantly larger than that in autumn in young Japanese subjects. In order to investigate this phenomenon further, the experiment was repeated on 22 elderly Japanese female subjects (61-78 yrs of age) during the four seasons of the year. The amount of unabsorbed dietary carbohydrate by the breath hydrogen test, which measures the amount of hydrogen in exhaled air, was then estimated. A 6 g solution of lactosucrose, an indigestible trisaccharide, was used for comparison. Two groups of subjects, 16 subjects in Osaka and 6 subjects in Nagano, were studied in the summer (July to August) and autumn (October to November) of 2005 and the winter (January to February) and spring (April to May) of 2006. The following results were found using the pooled data of the total of 22 subjects. With regard to the amount of breath hydrogen excretion of the lactosucrose solution, there was no significant difference between the four seasons. There was a significant seasonal change in the efficiency of dietary carbohydrate absorption from the intestine after breakfast. The percentage of total carbohydrate that was not absorbed was lowest in the spring and highest in the winter. A comparison of the results from studies on the elderly and young subjects revealed the percentage of total carbohydrate that was not absorbed in the elderly was significantly lower than in the young in the winter, spring, and summer. These results indicate that there is seasonal variation in the efficiency of dietary carbohydrate absorption from the intestine among elderly female Japanese subjects as well as young female Japanese subjects. They also suggest that the efficiency of dietary carbohydrate absorption from the intestine after breakfast is retained in these naturally active and healthy elderly subjects.

Comparison of carbohydrate digestion between Japanese and Polish healthy subjects.

We have revealed that light environment affects digestion and absorption of dietary carbohydrates in the gastrointestinal tract. This experimental result supposes that the efficiency of carbohydrate absorption may differ among people who live in different latitudes, such as Japanese and Polish people, at the same calendar season. In order to prove this hypothesis, we have been comparing the efficiency of carbohydrate absorption using the breath hydrogen test in Japan and Poland. Here, we report the comparison of the result obtained in the summer of 2004 as the following; (1) Orocecal transit time (OCTT) for indigestible trisaccharide of Japanese subjects was significantly longer than that in Poland (p = 0.043). (2) On the ingestion of minestrone, the amount of unabsorbed carbohydrate of Japanese subjects (which was estimated as trisaccharide equivalent) was significantly larger than that of Polish subjects (p = 0.006).

Seasonal variation in amount of unabsorbed dietary carbohydrate from the intestine after breakfast in Japanese subjects.

We previously showed that daytime dim-light exposure has a negative effect on the efficiency of dietary carbohydrate absorption in the evening, whereas evening-time dim-light exposure has a beneficial effect. These results suggest that seasonal changes in the environmental light may affect gastrointestinal activity, and that there might, therefore, be seasonal variation in the efficiency of dietary carbohydrate absorption from the intestine. In order to prove this hypothesis, we measured the amount of dietary carbohydrate unabsorbed from the intestine after a breakfast in healthy female Japanese subjects during the four seasons of the year. We estimated the amount of unabsorbed dietary carbohydrate by the breath hydrogen test, which measures the amount of hydrogen in exhaled air. A 6 g solution of lactosucrose, an indigestible trisaccharide, was used for comparison. Two groups of subjects, 12 subjects in Osaka and 14 subjects in Nagano, were studied in the winter (January to February), spring (April to May), summer (July to August), and autumn (October to November) of 2004. We found the following results: (1) In no season were there any significant differences between the two subgroups in the orocecal transit time of the breakfast and the lactosucrose solution. Nor were there any significant differences in the amount of unabsorbed dietary carbohydrate from the breakfast. (2) Using the pooled data of the total of 26 subjects, there was no significant seasonal variation in the orocecal transit time of the breakfast or the lactosucrose solution. (3) There was a significant seasonal variation in the amount of unabsorbed dietary carbohydrate from the breakfast. (4) The amount of unabsorbed dietary carbohydrate from the breakfast was largest in winter and smallest in autumn. Results in spring and in summer were similar and intermediate between those in winter and autumn. Post hoc multiple comparison tests showed that the amount of unabsorbed dietary carbohydrate in winter was significantly larger than in autumn. (5) In winter, the average ratio of the amount of unabsorbed dietary carbohydrate to the total amount of carbohydrate in the breakfast was about 12%; in autumn it was about 6%. These results clearly show that there is seasonal variation in the efficiency of intestinal dietary carbohydrate absorption among young female Japanese subjects.